Brain fog
Brain fog is a very common symptom of the perimenopause and menopause, and many women say that their brains feel like ‘cotton wool’. You might have noticed that you’re increasingly forgetful, can’t remember names, lose your keys, write endless to do lists, and find it hard to retain information. This can make it especially hard to function at work, and you might struggle to concentrate when reading or watching TV.
These symptoms can be so severe that you may even start to worry that you have dementia. This is particularly scary if you have a family history, and some women become so concerned that they are referred to have testing at a memory clinic. Fortunately, the right type and dose of hormone replacement therapy (HRT) (with testosterone for those who need it) can improve brain fog and help you think more clearly.
How estrogen and testosterone affect the brain:
Two of the main female hormones, estrogen and testosterone, play an important role in cognition and memory. When the levels of these hormones begin to fall during perimenopause and menopause, this can lead to a range of cognitive symptoms including memory loss, difficulty staying focused, word-finding difficulties, losing your train of thought and getting confused easily.
Estrogen stimulates the brain, keeps the neurons firing, supports the growth of new cells and helps existing cells to form new connections. When estrogen levels fall in midlife, your entire body – including your brain – goes into a sudden deprivation state. At a cellular level, estrogen pushes your brain cells to burn more glucose, which is its main fuel. Studies have shown that there is an overall reduction of brain energy levels during menopause, which can trigger hot flushes, night sweats, anxiety, depression, brain fog, and the host of other cognitive symptoms mentioned.
Testosterone (produced by the ovaries too) strengthens nerves in the brain, and contributes to mental sharpness and clarity, as well as overall energy levels. It also strengthens arteries that supply blood flow to the brain, which is crucial to protect against loss of memory.
The good news is that we can support brain health with simple lifestyle changes. Although memory loss and brain fog can be alarming when they happen, there’s no need to panic about these menopausal effects on the brain. Midlife is a turning point, and there are many things you can do to support brain function.
A Healthy Diet:?
There are clear links between what we eat and our hormone balance. A brain-friendly diet is one rich in polyunsaturated fatty acids, such as Omega 3 and Omega 6, which are found in eggs, fish, nuts and seeds. Your brain will thank you for giving it plenty of these nutrients.
Another important dietary consideration on is giving your brain antioxidants, in particular vitamins A, C and E. The brain is the most metabolically active organ in the body. When it burns glucose, free radicals are formed which have unwanted effects in your body, including the brain, as they make your cells age faster and work less efficiently. It’s important to have antioxidants in your diet as they can balance out these free radicals and minimise the negative impact of them on your cells.
Regular Exercise:
Regular exercise can also support brain health – it’s important to keep active by doing an activity that you enjoy. If you’re not keen on going to the gym or joining a fitness class, yoga is a great way to relieve stress and promote relaxation. Going for a daily walk can improve fitness and increase mental and emotional wellbeing.
It can be challenging to start a new nutrition and exercise plan, especially if you’re dealing with menopausal symptoms. The key is to make small, sustainable changes that become part of your everyday routine. Many women find that their energy and motivation to exercise increases when they start taking HRT.
Deep Sleep:
It’s common to have trouble sleeping during the perimenopause and menopause, as the brain can’t regulate sleep properly without the hormones, estrogen and progesterone. If you struggle to fall or stay asleep, or you wake up in the middle of the night, there’s a good chance you’re missing out on some of the deep sleep, that’s most beneficial for your brain. Deep sleep is when all the toxins and impurities are removed, so this phase of sleep is important to keep the brain healthy.
For this reason, it’s wise to take steps to improve your sleep habits, such as limiting screen time before bed, keeping your bedroom cool, dark and comfortable, and using pillow sprays or aromatherapy oils to help you feel calm and relaxed.
Most women find that the quality of their sleep dramatically improves when they begin taking HRT. Better sleep also boosts mood, energy levels and concentration, helping the cloud of brain fog to lift.
Preparing for your appointment
If your local surgery offers double appointments it’s a good idea to book one of these so that you’ll have enough time discuss your symptoms and concerns. Before your appointment, take a look at the symptoms list to record the menopausal symptoms that you’re experiencing.
Make a note of any changes to your periods, and bring a list of any medications that you’re taking, including herbal supplements. It’s also wise to jot down any questions or concerns, so that you don’t forget to mention them during your appointment. If you’re feeling anxious, you can bring along a friend or family member for moral support.
Your first appointment
According to the 2015 NICE menopause guidelines, your doctor should discuss the following:
- the stages of menopause
- common symptoms of the menopause
- how the menopause is diagnosed
- lifestyle changes that can help your health and wellbeing
- benefits and risks of treatment
- how the menopause can affect your future health
Your doctor may want to carry out blood tests to check your hormone levels, but this isn’t usually necessary as these can vary by the hour. Most women can start HRT without needing any investigations or blood tests.
Sometimes your doctor may want to carry out blood tests to rule out other underlying issues, such as an underactive thyroid, and they will also check your blood pressure.
If you would like to take HRT and you feel you would benefit from taking it then you should ask at your first appointment for a prescription of HRT. The majority of women benefit from taking HRT and women can start taking HRT during their perimenopause. No women is usually too old to start taking HRT, even if it is many years since your menopause then you should still be able to take HRT.
Try to leave the room with as many questions answered as possible, ask if your doctor has any leaflets or information they can share with you, and check if you need a follow-up appointment. NICE guidelines recommend a review three months after your first appointment, but you should ask for an earlier review if you are experiencing side effects or the treatment doesn’t seem to be working.
A second opinion
Unfortunately, some doctors and healthcare professionals still believe outdated reports that HRT is linked to cancer, blood clots and heart problems, so they may be reluctant to prescribe HRT. If there’s no medical reason why HRT is unsuitable for you, then it’s important to speak up and, if necessary, ask for a second opinion.
You could ask to speak to another healthcare professional at your surgery, or ask to be referred to a specialist. Alternatively, you could refer yourself to a private menopause clinic. In the UK, the British Menopause Society has a register of recognised menopause specialists at thebms.org.uk. If you live outside the UK, you can contact the International Menopause Society.
What happens if my doctor / nurse won’t give me HRT?
- Informing your doctor about what you are wanting to discuss prior to the appointment or at the start of your consultation will help to ensure you get the most out of your consultation.
- Know your rights as a patient. Doctors will be more likely to consider your views if you can show you are fully informed and understand what any risks are and explain clearly why you still wish to have that treatment option because of the benefits to your life and health you believe it would bring.
- Be persistent but polite. If you do not get the desired outcome at the first appointment, try again another time. You can ask to see another doctor within your practice.
In general, your best approach when talking to your doctor about your menopause is to clearly state your reasons for what you would like, explain what information has led you to this decision, and that you know what the associated risks might be but that it is still what you choose to do. This information may need repeating on several occasions, to several doctors or nurses, but persistence often pays off when you can give a clear and rational argument that shows careful consideration of the evidence of the benefits to your health.